‘Low-risk youth?’ : students, campus life and HIV at a university in Zimbabwe

University and government authorities in Zimbabwe, and indeed in many African countries, have tended to downplay the presence of HIV and AIDS on university campuses. The general belief seems to be that university students’ high levels of schooling somehow protect them from HIV infection, even though existing evidence suggests otherwise. Consequently, very little is known about university students’ specific vulnerabilities to HIV infection. The few interventions that are being implemented in university campuses are often based on generic models of ‘youth sexual behaviour’ that fail to take into account the many ways that university students’ experiences are different from those of other young people. Through the use of ethnography, the thesis examines how institutional factors and ‘campus cultures’ shape students sexual behaviour at the University of Zimbabwe, as well as students’ expectations from intimate relationships and the meanings that they attach to sex, sexuality, love and romance. A key point I make throughout the thesis is that where individuals are located - both spatially and temporally - is just as important for understanding youth sexuality and the HIV epidemic as are other ‘risk’ factors, such as socio-cultural beliefs and poverty. The thesis also explores how ‘HIV risk’ is constituted, understood, deployed and avoided by university students. I argue here that ‘HIV risk’ behaviours such as transactional sex, multiple and concurrent partnerships and the non-use of condoms take on vastly different meanings when they are practiced by university students and within the context of a university campus. It is therefore incorrect to abstract ‘HIV risk’ behaviours from their immediate contexts as many interventions do.Thesis (DPhil)--University of Pretoria, 2011.Anthropology and Archaeologyunrestricte

'They think that gays have money': gender identity and transactional sex among black men who have sex with men in four South African townships

Transactional sex has not been studied much among men who have sex with men in Africa. Consequently, little is understood about attitudes towards the practice, the circumstances that give rise to it or how transactional sex relationships are managed. We conducted in-depth interviews with 81 Black men aged 20-44 from four low resourced townships in Tshwane, South Africa. We found that transactional sex was a widely used strategy for initiating and sustaining relationships with regular and casual partners, and was motivated by both the need for subsistence and for consumption. Alcohol-based exchanges in particular provided men in the townships with a covert and safe platform to communicate erotic, sexual and romantic attraction to other men, and bars and other drinking places were a popular venue for meeting potential sexual partners. The majority of 'feminine-identifying' men had engaged in transactional sex as the providers of money and material goods compared to men who identified as either 'masculine' or as 'both masculine and feminine'. Surprisingly, however, this did not necessarily give them greater control in these relationships. Our study provides an initial foray into a complex sociosexual phenomenon and suggests that gender identity is an important construct for understanding transactional sex relationships among men in Africa.

"Gays have money": the gendered nature and meanings of transactional sex among black men who have sex with men in South Africa

Poster presented at the XIX International AIDS Conference, Washington, USA, Jul

Black South African MSM's disclosure of sexual practices and identity and family's responses

Paper presented at the 5th Africa Conference on Sexual Health and Rights, Windhoek, Namibia, 19-21 Septembe

‘These people who dig roots in the forests cannot treat HIV’: Women and men in Durban, South Africa, reflect on traditional medicine and antiretroviral drugs

Relatively few empirical investigations of the intersection of HIV biomedical and traditional medicine have been undertaken. As part of preliminary work for a longitudinal study investigating health-seeking behaviours among newly diagnosed individuals living with HIV, we conducted semi-structured interviews with 24 urban South Africans presenting for HIV testing or newly enrolled in HIV care; here we explored participants’ views on African traditional medicine (TM) and biomedical HIV treatment. Notions of acceptance/non-acceptance were more nuanced than dichotomous, with participants expressing views ranging from favourable to reproachful, often referring to stories they had heard from others rather than drawing from personal experience. Respect for antiretrovirals and biomedicine was evident, but indigenous beliefs, particularly about the role of ancestors in healing, were common. Many endorsed the use of herbal remedies, which often were not considered TM. Given people’s diverse health-seeking practices, biomedical providers need to recognise the cultural importance of traditional health practices and routinely initiate respectful discussion of TM use with patients

Perspectives on HIV pre- and post-exposure prophylaxes (PrEP and PEP) among female and male sex workers in Mombasa, Kenya : implications for integrating biomedical prevention into sexual health services

Pre- and post-exposure prophylaxes (PrEP and PEP) can reduce the risk of HIV acquisition, yet often are inaccessible to and underutilized by most-vulnerable populations, including sex workers in sub-Saharan Africa. Based on in-depth interviews with 21 female and 23 male HIV-negative sex workers in Mombasa, Kenya, we found that awareness and knowledge of PrEP and PEP were low, although willingness to use both was high. Participants felt PrEP would be empowering and give added protection against infection, although some expressed concerns about side effects. Despite PEP's availability, few knew about it and even fewer had used it, but most who had would use it again. Sex workers valued confidentiality, privacy, trustworthiness, and convenient location in health services and wanted thorough HIV/STI assessments. These findings suggest the importance of situating PrEP and PEP within sex worker friendly health services and conducting outreach to promote these biomedical prevention methods for Kenyan sex workers

Intentional and unintentional condom breakage and slippage in the sexual interactions of female and male sex workers and clients in Mombasa, Kenya

We examined why male condoms broke or slipped off during commercial sex and the actions taken in response among 75 female and male sex workers and male clients recruited from 18 bars/nightclubs in Mombasa, Kenya. Most participants (61/75, 81%) had experienced at least one breakage or slippage during commercial sex. Many breakages were attributed to the direct actions of clients. Breakages and slippages fell into two main groups: those that were intentionally caused by clients and unintentional ones caused by inebriation, forceful thrusting during sex and incorrect or non-lubricant use. Participant responses included: stopping sex and replacing the damaged condoms, doing nothing, getting tested for HIV, using post-exposure prophylaxis and washing. Some sex workers also employed strategies to prevent the occurrence of condom breakages. Innovative client-oriented HIV prevention and risk-reduction interventions are therefore urgently needed. Additionally, sex workers should be equipped with skills to recognize and manage breakages